All lectures are held in the Department of History and Philosophy of Science.

Michaelmas Term

Ethics and Politics of Science and MedicineStephen John (4), Tim Lewens (4)

Mon 4pm (weeks 1–8)

Lent Term

Ethics and Politics of Science and Medicine (continued) Stephen John (4)

Mon 4pm (weeks 1–4)

Philosophy of the Biomedical Sciences: Concepts and EvidenceJacob Stegenga (8)

Tue 4pm (weeks 1–8)

Quantifying HealthAgnes Bolinska (4)

Mon 4pm (weeks 5–8)

Do we have a human right to health? What is it to be healthy anyway, and can good health be measured? How can we know that smoking causes lung cancer, rather than that they are merely correlated? Is it ethical to experiment on humans to gain that knowledge? Is the foetus a person, and does this affect the morality of abortion? How should we decide between funding basic science and applied studies? Medical practice raises significant philosophical, ethical and political questions. This course studies these questions and shows how different answers may influence practice.

Aims and learning outcomes

to introduce students to core issues in the ethics of medical practice and the politics of health policy;

to provide students with conceptual tools for understanding the ethics and politics of medicine more generally;

to introduce students to core debates over the epistemology and metaphysics of biomedical and health-related research and practice;

to provide students with resources for thinking through emerging paradigms in medical research;

to help students to understand how 'ethical' and 'scientific' concerns inter-relate in core areas of medical research, such as the measurement of health or the value-ladenness of inference;

to enable students to take on roles as engaged citizens and practitioners.

Lectures

This course considers two important sets of questions. In the first four lectures, we look at some of the central questions of bio-medical ethics, focusing in particular on issues of autonomy and consent in clinical and research settings. In the second group of lectures, we turn to consider the broader political and institutional settings which influence population health, paying particular attention to questions of the allocation of scarce resources, and the proper ends of – and limits to – public health policy.

A fundamental goal of medical research is causal inference. Does eating meat cause cancer? Will this drug cure my disease? Is poverty a cause of heart disease? Medical science has a variety of tactics to provide evidence for causal hypotheses, and these tactics raise a plethora of philosophical questions. For example, many epidemiological hypotheses are based on animal research. What are the conditions under which we can extrapolate findings in animals to conclusions about humans? Another example: many statisticians and epidemiologists, especially in the evidence-based medicine community, claim that evidence from randomised controlled trials is the best kind of evidence for causal hypotheses, and other forms of evidence are less reliable. What's so special about the role of randomisation in medical research? Beyond such methodological questions, it is important to note that medical science occurs in a complicated social nexus. This social nexus forms the conditions under which medical science can achieve a degree of objectivity, but aspects of that social nexus threaten that very objectivity.

Quantifying HealthAgnes Bolinska (4 lectures, Lent Term)

Quantifying overall health states enables decision-making about how to distribute limited healthcare resources. Yet health is multidimensional: a broken arm, depression, hearing loss, influenza, chronic pain and Alzheimer's disease each diminish one's health in different ways, and it's often not clear how these can be compared. Can health itself be measured, or should we instead aim to quantify its value? Is the value of a health state objective? If not, whose values matter, and how can they be measured? How is health related to well-being, and what are the implications of this relationship for the quantification of health? We critically examine current attempts to quantify health such as the quality-adjusted life year (QALY) and disability-adjusted life year (DALY). What do these measures quantify, and are they adequate? We conclude by asking whether using QALYs in cost-effectiveness analysis for the distribution of healthcare resources discriminates against people with disabilities or the elderly.